Classifying caesarean section to understand rising rates among Palestinian refugees: results from 290,047 electronic medical records across five settings

Table 2 Reimbursement policies and cost of caesarean sections exceeding WHO guidelines. Vaginal and caesarean-section deliveries are covered differently in the five settings as per policies shown in the table below

Average costs paid by UNRWA per patient delivery and current childbirth policy reimbursements by setting
	Jordan	Lebanon	Syria	West Bank	Gaza
Vaginal delivery	Average USD 74 UNRWA covers 75% of the cost up to 100 JOD (equivalent to 140 USD in 2020)	Average USD 230 UNRWA covers 275,000 Lebanese Lira (Equivalent to USD 183 in 2017 and USD 15 in 2020)	Average USD 50 UNRWA covers 75% of the cost	Average USD 150 UNRWA covers 50% of the cost	Average USD 87
Caesarean section delivery	Average USD 300	Average USD 580 UNRWA covers 100% of the cost in Palestinian Red Crescent Society hospitals, 90% in Secondary hospitals, 60% in Tertiary hospitals	Average USD 100 UNRWA covers 75% of the cost	Average USD 510 UNRWA covers 75% of the cost	Average USD 430
SSN/ poor hardship	UNRWA covers 95% of the cost up to 150 JOD (equivalent to 211 USD)		UNRWA covers 95% of the cost	UNRWA covers 90% of the cost	Average 90 USD for vaginal; 445 USD for caesarean

The unit cost for deliveries that UNRWA has agreed with service providers differs according to the contract in place in the five settings. UNRWA only covers deliveries submitted within the Hospitalization Support Program and not all the deliveries recorded in its health centers. Palestinian Refugees might choose alternative solutions (governmental or private insurance scheme where available). Under the assumption that all deliveries would have cost as per UNRWA agreements, a total of USD 52.3 million would have been spent in 2017–2020: USD 20.3 million for vaginal deliveries and almost USD 32 million for caesarean-sections. USD 6.8 million of the latter amount could have been saved had guidance been adhered to (USD 1.9 million by exceeding guidance in group 1 + 2 (nullip, term), almost USD 1.4 million in group 3 + 4 (multip, term, no prev caesarean-section), USD 2 million in group 5 (multip, term, prev caesarean-section), and USD 1.5 million in group 10 (preterm))

ISSN: 1471-2393